P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Akin ◽  
V Garcheva ◽  
J T Sieweke ◽  
J Tongers ◽  
L C Napp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Life Support ◽  
Neuron Specific Enolase ◽  
Good Neurological Outcome ◽  
Male Predominance ◽  
S 100 ◽  
Hospital Cardiac Arrest

Abstract Purpose To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts. Methods Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA. Results Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l. Conclusion Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

scholarly journals Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245210
Author(s):  
Muharrem Akin ◽  
Vera Garcheva ◽  
Jan-Thorben Sieweke ◽  
John Adel ◽  
Ulrike Flierl ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Clinical Decision Making ◽  
Cerebral Performance Category ◽  
Neuron Specific Enolase ◽  
Clinical Decision ◽  
St Segment Elevation ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

Background Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined. Methods We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC). Results Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16–94] vs. 119μg/l [25–406]; p<0.001, for survivors vs. non-survivors, and 21μg/l [16–29] vs. 40μg/l [23–98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127μg/l [0.063–0.360] vs. 0.772μg/l [0.121–2.710], p<0.001 and 0.086μg/l [0.061–0.122] vs. 0.138μg/l [0.090–0.271], p = 0.009, respectively. For mortality, thresholds of 36μg/l for NSE and 0.128μg/l for S-100b could be determined; for poor neurological outcome 33μg/l (NSE) and 0.123μg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74–88) and 79% (71–85) for S-100b. Conclusions Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.

scholarly journals Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Life Support ◽  
Neurologic Outcome ◽  
Good Neurological Outcome ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is considered an important health care problem because it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policymakers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing. Objective: This study aimed to determine whether advanced life support (ALS) under physician’s direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project. Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and family’s unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome. Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group. Conclusion: An emergency medical system intervention using the SALS protocol was associated with a significant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.

scholarly journals The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support

2019 ◽  
Vol 27 (5) ◽  
pp. 286-292
Author(s):  
Choung Ah Lee ◽  
Gi Woon Kim ◽  
Yu Jin Kim ◽  
Hyung Jun Moon ◽  
Yong Jin Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Epinephrine Administration ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest. Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics. Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group. Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Neurological Outcome ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Good Neurological Outcome ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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